MEDICARE: TELECARE MENTAL HEALTH SERVICES OF TEXAS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1912106584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELECARE MENTAL HEALTH SERVICES OF TEXAS, INC

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	SUITE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	510-337-7950
Fax Number	:	510-337-7969

Provider Business Practice Location Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	SUITE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	510-337-7950
Fax Number	:	510-337-7969

Authorized Official
Title or Position	:	CFO,VP
Name	:	MARSHALL LANGFELD
Credential	:
Telephone Number	:	510-337-7950

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	01/14/2008

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